Tag: balance

What You Should Know If You Have Been Diagnosed With Borderline Personality Disorder

Here is the truth: BPD, or Borderline Personality Disorder, has a historically bad rap with mental health professionals. I’m going to give you some truths to what you should know to not only think about this clearly, but to consider your options in terms of the person you want to be and the person you want to become.

BPD was historically known for “bordering” on the lines of neurotic vs. psychotic. In the olden days, clinicians who didn’t know if a person was living in the confines of “reality” could put them in a category that didn’t really fit either one. Historically neurosis has to do with issues related to anxiety, mood, and depression. Neurosis can also be related to trauma, vigilance, and paranoia about bad things re-occurring. Psychosis is related to problems hearing and seeing things that others do not see or hear, and is often associated with schizophrenia. “Borderline” has often been referred to as a category that doesn’t really fit any category, and in some cases has been the in- between of no-place.

BPD is also historically written about from an extremely pejorative and hopeless point of view. Words like “manipulative, gamey, cagey” are often used, and mental health professionals often refer to this diagnosis when talking about people that bug them, that they do not like, that get them enraged, and people that can tie up crisis hotlines and emergency rooms. In many cases, labeling someone with BPD has become a substitute for observing and describing behavior, providing useful feedback, and encouraging people to behave in ways that make them competent and more effective.

Here are some truths that you should keep in mind if a mental health professional has “informed” you that you have BPD:

Mental health diagnoses are not valid nor reliable. This means that (in terms of validity), if the same professional assessed a person over time (such as an assessment 20 years ago, 10 years ago, and 5 years ago), the likelihood that that professional would give the same person the same diagnosis is unlikely. It also means that if many different mental health professionals assessed the same person it is highly unlikely the all of them would come to the same conclusion about diagnosis. This is assuming that the only measure of giving a diagnoses is a working familiarity with the DSM-TRV, or the “psychiatric Bible” of diagnostic criteria (which is highly controversial. Be aware that homosexuality was once considered a psychiatric disorder, and now it is not). Mental health diagnosis may be more reliable and valid if the diagnosis is given based on a range of valid and reliable assessment batteries; thus if you have had some comprehensive personality assessment and testing this may be less of the case for your situation. Bear in mind that most people in the counseling profession are doing nothing more than giving you their clinical opinion; hence my point about reliability and validity. Also, there are some counseling programs that don’t cover concepts such as instruments of mental health measurement.

For some mental health professionals, telling someone they have BPD can sometimes be a communication of frustration. In a helpful world, telling someone what diagnoses they have can be useful and even helpful- it can validate if a person really is depressed or help figure out specific treatments. In the case with BPD, the “right treatment” is more complicated and may not be readily available. If your mental health professional is telling you have BPD, you might want to consider: So what? How it is it helpful or useful? Does it help people have the resources or tools for solving painful problems? Is it specific enough to describe what behavior shows up- and how behavior can be changed? Does it provide access to literature that is actually helpful? For some people, being diagnosed with BPD can only serve to increase shame and self-loathing. Literature is not always helpful and mental health professionals don’t always shore up resources for how to move forward to obtain resources and supports. Is the expectation to hide in a corner the rest of your life and not tell people who you “really” are? And do you seriously want to live this way?

There is a lot of confusion for most people around diagnosis being a cause. Diagnoses are actually descriptions of behavior, and mainly identify patterns of responding or behaviors that are typical for a person. Many people, including some mental health professionals, actually believe that they are describing reasons or causes of behaviors when giving someone a diagnoses. For instance, if the way that you behave is because you have a disorder, then someone people think they have adequately not only explained the reasons you behave the way you do, but they think they know why you behave the way you do. In terms of diagnosis, this really is not the case. The failure of the mental health system is that people think they are being helpful (“You have problems because you have a disorder”) rather than addressing causes and potential solutions for behavior change. In this case, many problems of pain are not being solved as the focus of attention is on the “correct” diagnosis, which, in my opinion, is a rather useless pursuit. It can be akin to a parent who has several children; one of them is determined to be “bad.” Instead of figuring out how to prevent problem behavior, solve problems, and tend to the child’s needs; the parent simply attributes all problem behavior to the child being “bad.”

What you can do if you have, or think you have, or someone else thinks you have BPD:

Don’t think you are permanently impaired, hopeless, or beyond help. Fear and shame keeps may people paralyzed from acting with self-respect, doing things that are meaningful, and putting oneself out there in the universe. Universally, fear and shame can prevent anyone from living a decent life. You are not an exception.

Learn to talk about yourself and your behaviors in a descriptive, non-judgmental, and matter-of-fact ways. This will make you competent, understandable, and respectable. This also means that if you go around and tell everyone you are disordered, people may treat you as fragile, incompetent, incapable, or helpless. Create and practice ways to talk about yourself outside of the realm of “mental illness.”

Pay attention to providers, mental health professionals, or family members who attribute your behavior to being “mentally ill” or “bad” or “personality disordered.” Realize that everyone has vulnerabilities and that many, many people struggle with giving accurate, helpful, and specific feedback. Consider how giving and receiving feedback is either helpful or not helpful, and don’t seek out relationships where blame seems to be an acceptable solution for reducing pain or resolving differences. Finding “fault” only works if the consequence is taking responsibility and making changes; not amplifying shame and paralysis of action.

Be aware that if you do delve into literature on BPD, you may encounter a wide range of confusing terminology that attempts to define you; which may not only be disconcerting but also downright confusing. You might encounter terms like object relations, transference, countertransference, self-objects, self-soothing self-objects, object mirroring, intrapsychic processes, or projections. Don’t get bogged down by mental health-ese. Bear in mind that some mental health professionals have a lot of trouble observing and describing behavior and giving useful feedback and sometimes hide behind their own jargon.

Find other things that provide you a sense of identity, that define you, that make you the person you are, and that you value. Consider roles you take on in society; engage in them and be proud of them. What is important to you? Why would you let a diagnoses get in your way with pursuing what is important to you? In what ways do you not “show up” because you have shame around a diagnosis? Life is bigger than the world of “mental health.”

Bear in mind that many mental health professionals are obsessed with political leaders that they believe to be personality disordered. In truth, political leaders are still political leaders, and political leaders have made great gains, influenced many, changed laws, and maintained power. Being diagnosed with something “bad” hasn’t deterred people from being politically active, advocating, having power, or being influential. There is no good reason why you have to be shamed from participating in the universe just like everyone else- people with a lot of problems still manage to be successful and competent in a myriad of different ways.

Finally, feel free to visit the National Education Alliance for Borderline Personality Disorder, a nonprofit that may be more helpful than the general google search. Their website (www.borderlinepersonaltydisorder.com) has some useful non-pejorative literature, trainings, and free services for friends and family members.

Should I Get Back On The Horse? Two Ways To Approach Your Fear That Won’t Work.

If you get thrown off a horse, should you get back on? Some people will suggest that you need to get back on the horse immediately so that you will gain mastery over your fears. If you don’t get back on the horse, then your fear will haunt you the rest of your life.

Is this really true? Here are some ways of approaching fear that isn’t very effective. The first is to fight your fears or treat the situation like a battle zone. It means taking the reins, having control of the situation, bucking up, grinning and bearing it, tightening your muscles, and powering through. It can be coercive and forceful. In some cases it means blinding yourself, dissociating or disconnecting from the fear, or minimizing or reducing the value of what your fear might be trying to tell you. Generally it is doing the thing that you are afraid of as a way to prove yourself or prove your point.

The reason this doesn’t work is because it often means engaging in life as if it is a battle. Staying in the battle field often means getting hurt, risking relationships with others, being coercive, or putting the other on the defensive. Getting back on a high strung or agitated horse to gain mastery over fears is not an effective way to manage fear.

The other ineffective way of handling fear is to completely avoid anything associated with the fear. This means that any mention of the feared object or situation is avoided. Conversations stop, people stop making eye contact, the air becomes stilted and stale, people avoid people, and people avoid a wide range of stimuli that becomes associated with the feared situation. The person may be humiliated that they gone thrown off a horse, so they go out of their way to hide it. While people lead perfectly fulfilled lives without riding horses, the person who can’t drive past a barn, watch a television show with a horse on it, have a conversation about what happened when they were thrown off a horse, or set foot on a farm may find themselves restricted in ways that have nothing to do with riding the horse itself.

Handling fear effectively means being able to approach the situation with a flexible style that involves both challenging oneself, listening to the validity of the fear, being kind to oneself, backing off when things are too overwhelming, identifying smaller steps to approach the fear, and figuring out why the situation/ issue/ activity is important to you.

Fear is a useful emotion in that it provides information about oneself and one’s situation. Fear protects us from danger, gets us out of threatening situations, and helps us cope adaptively. Fear can also be so extreme that it takes over our lives, restricts our ability to do the things that are important to us, or prevents us from having a life- the life we want.

Here are a few questions to help you figure out your fear:

  • What about the situation, event, activity, or relationship is important to you? You may decide not to ride horses ever again, but does this fear bleed over into other areas of life that prevent you from doing what matters? If riding horses is not important to you, and it doesn’t get in the way of your life otherwise, it may not be an issue.
  • What does your experience- and your fear- tell you? Your fear may be telling you that getting back on an agitated horse is indeed a bad idea. So don’t go out and get hurt if it isn’t necessary. If horses aren’t your thing, let it go and move on. Don’t let your humiliation keep you attacking something that isn’t going to service you.
  • If you want to approach your fears, what would be the smallest step? Watching a TV show about horses, visiting a barn, feeding a horse, brushing a horse, walking a horse, and hanging out with horses are all behaviors that don’t include absolute avoidance but don’t force you into a situation that is potentially unsafe. You could also ride a smaller, more mellow horse with the help of a trainer.
  • If you are going to do the smaller steps, don’t white knuckle it. Relax your facial muscles, soften your jaw, breath slowly/ deeply/ evenly, maintain an open body posture, and take in the situation fully. If this feels threatening, do a smaller step- or limit the time you spend doing the activity. For instance, you could watch a TV show about horses for one minute, five minutes, or fifteen minutes. If this doesn’t challenge you, up the ante by going out to a barn. Find your middle ground, back off when you are overwhelmed, give yourself credit for your efforts, treat yourself kindly, and challenge yourself at some point in the future when you are in a better place.

What if I’m wrong?

Here are a couple of thoughts on the business of being “wrong.” First, the question itself begs a certain dichotomy to form in a relationship. It implies a one-up, one-down position. It can make one person more powerful, keep another at a distance, or in extreme circumstances serve as an opportunity to belittle or berate. What does being “wrong” imply about the relationship, the importance of keeping a relationship, or the way that people will continue to relate to each other? Is it worth it to damage or hurt a relationship to be “right”? If one person is “wrong”, then how is the relationship handled in the future? How do people move forward?

Next, being “wrong” might be rephrased as being technically inaccurate. If you are responding in a way to that does not match reality in a reasonable sort of way, you may be considered “wrong.” However, in some circumstances this begs the question of differences in opinion, perception, feelings, and agendas. A person can have a valid point of view, see things differently, or see aspects of a situation that another person is not able to see. This can prevent communities from being rigid, thinking “inside-the-box”, refusing to consider alternatives, or being racist or non-diverse in their thinking. Trying to understand the validity in where others come from can help us be more understanding, have better relationships, be more forgiving, and become less “stuck” in the right/wrong dichotomy. If you are technically “wrong”, this also might be your opportunity for self-correction, learning, or growth. Consider teasing out the differences of being “wrong” vs. being technically accurate, and if being “wrong” has anything to do with conflict around perspective, perception, intention, or emotion.

In addition, there is a certain cost to being “wrong.” Everyone at some point in their life has probably had an experience in which they thought something to be true, accurate, or reasonable but found this to not be the case. The cost to being “wrong” is often related to embarrassment, shame, humiliation, or perhaps the loss of trust or leadership. Are you able to correct your actions based on what happened? Can you tolerate the pain of your own humiliation and consider what really matters? If the inability to bear the cost of being “wrong” results in isolation, criticism, withdrawal, and becoming more adamant that you were “right”; you may want to give some thought to what it is costing you in terms of your relationships.

Here are some final questions for you to consider:

  • What are your intentions? Sometimes we are in long term work, romantic, or family relationships that must be giving careful consideration.
  • What are the intentions of the other person? (Are you sure, or are you assuming? What evidence do you have?)
  • What is the true cost of being told you are “wrong”? What do you have to gain by making sure others know you are “right”?
  • If you are “wrong,” can you tolerate your embarrassment enough to grow, learn, regroup, or reconsider how you will handle future situations?
  • Is it more important to be right than to be effective? (Consider what the relationship means to you and if your own self-respect in handling the situation is on the line).
  • Are you unforgiving of other people when they are “wrong”, thus unable to forgive yourself? Is your own criticism preventing you from moving on, getting unstuck, or responding in a way that is potentially painful but perhaps necessary?

What to do instead of criticize yourself

Try softening your stance, gently relax your face, and allow your muscles to become loose and less tight. Put a hand over your heart with an intention of lovingkindness, and try repeating the following statements with a tone of voice that conveys self-compassion:

May I bear this pain with kindness to myself

May I safely endure this pain

May I accept the circumstances of my life

May I find peace in my heart

May I let go of what I can not control

May I remember that others are also suffering

 

Quick tips on ways to manage your irritability

When did you last eat? Irritability because you are hungry is common, but many people underestimate how important it is in managing emotion. Irregular eating habits, using caffeine/ sugar/ carbs to fill oneself up, and overeating when overly hungry can have a big impact on mood management.

Are you going through biological changes? Medication changes, alcohol use, dehydration, sickness, pain, smoking habits, caffeine dependency, and menstrual cycles all affect how we feel. Taking care of your biological wellbeing will help you take care of your psychological well-being. If possible, consider saving that “difficult conversation” for later- and not when you are at your biological worst.

How is your sleep hygiene? Get to bed at a reasonable hour, use the bedroom only for sleeping, and generate calming routines before bed. Don’t overestimate how irritability is more likely to s how up when you stay up extremely late or sleep all day.

Is the weather getting to you? Extreme temperatures can make people irritable. Get out of the cold or the heat. Make use of bright lights, warm temperatures, and potential social gatherings when it gets dark early.

When is the last time you did something you liked, enjoyed, or looked forward to? Doing things you enjoy will put you in touch with positive feelings, even if they are temporary. Do more of what you love, especially if you are in the middle of a crisis. Making time to do so is critical.

When is the last time you worked hard to accomplish something difficult? Building mastery and surviving challenges gives us a sense of accomplishment that can happen despite painful life circumstances.

When is the last time you had a tricky relationship situation and you feel proud of how you handled it? Remember that approaching situations with some element of acceptance can enable us to be more flexible; creating more options for the other party and making them feel less trapped.

Have you been told to change your “bad mood”?

Here are some steps to figuring out your mood- and what to do if, indeed, you want to change it.

Our moods- or our feelings- can be extremely important in helping us understand ourselves, organize our behavior, know what matters, and have better relationships. One of the first steps to figuring out feelings is to be able to describe, understand, and put words on experience. Think beyond just being in a “bad mood”: Try figuring out what, exactly, you are feeling. Instead of thinking about your mood as bad or good, try approaching this task with curiosity. Are you down, flat, depressed, lethargic, or disinterested? Are you irritable, angry, frustrated or impatient? Are you struggling with loss or sadness? Remember that feelings give us information about ourselves, our situations, and the people around us.

Next, consider what is valid, relevant, and sensible about what you are feeling. Some reasons that others tell us to stop being in a “bad mood” is because they want us to behave a certain way. Consider this: If the person telling you to stop being in a “bad mood” got what they wanted, what specific action would that entail? If you stopped being in a “bad mood”, would you stop avoiding conflict, go to work, keep a relationship, participate fully in an activity, or attend a social event or function? We may know and understand our mood, and have a good reason to feel the way we feel, but our mood gets in the way of rising to the occasion and meeting an obligation.

Expressing negative feelings frequently or pervasively can hurt relationships; on the other hand never being to share our innermost pain can prevent us from having more meaningful and connected relationships. In other words, ranting, venting, or complaining can join people in their beef against the universe, while expressing vulnerability can increase caring and intimacy. Consider how acting or expressing how you feel works or doesn’t work for you. Does it bring you closer to the people you care about, or does it tend to push them away?

Next, consider if you want to change how you feel. Is someone else trying to get you to change how you feel? If so, trying to change how you feel can be much less effective.

One way to change how you feel is to act in ways that are incompatible with how you feel. In some situations, acting on how we feel can enable us to feel congruent and genuine with what is going on for us on a more personal level. However, sometimes moods are so pervasive that they interfere with our lives. If your “mood” is interfering with your ability to organize action, meet obligations, make deeper connections with others, keep relationships, or engage in meaningful activity, it might be time to experiment with alternative behaviors to shift gears, engage your brain differently, or do something you wouldn’t typically do.

Here are some suggestions: Express appreciations to other people, talk about what you value in the relationships you have, avoid “complaining”, practice not talking about anything negative, shift gears by doing an activity that demands your attention, shift gears by doing a something physical (washing dishes, raking leaves, taking care of a child), become invested in someone else’s problem or dilemma, try generating compassionate reasons for why people behave the way they do, soften your body and facial expression, wish other people well, do something that challenges you, do an activity you like or enjoy, or do an activity for someone else that they like or enjoy. Doing these things even if you don’t feel like it– may help you change your mood all by yourself.

Is everything really going to be okay?

When people tell you that everything is going to be okay, sometimes it is helpful to hear. Sometimes it is soothing, and can give you a sense of hopefulness and shared understanding. There are many ways in which other people try to soothe us, and which we find help and assurance in cases of extreme distress.

However, people sometimes use this statement in a way that is unhelpful. For instance, the statement that everything is going to be okay may be an attempt to avoid the subject, offer a platitude, or inhibit communication of distress. Sometimes it is more helpful to obtain some acknowledgment or understanding of how you really feel. Sometimes worries, fears, or concerns about the future just need to be openly expressed. In addition, it is hard to know that things are going to be okay when you don’t have a way to solve the current problem.

The statement that everything is going to be okay is a statement of expressed hope. It can be offered to the person who is going through the most severe of all crises, and even though there may be some irony to it, there is some truth to it as well. Sometimes when we feel very hopeless it is hard for us to hear the usefulness of this statement. Sometimes in the worst of moments we can find and create experiences of hope and joy- despite significant loss. Being able to find and participate in these moments help people survive.

Thinking about the ways in which this statement is both helpful and not helpful at the same time can help us to create space for different perspectives. When we can see things from different angles, we have more flexibility in addressing situations, responding to our environment, and finding help that may actually be helpful. There is always some element of truth to things turning out okay, but there are also moments when hopelessness prevails. Sometimes it is nice to consider the kindness of another person’s intentions, even if their attempts to be helpful aren’t always exactly what we need to hear in our moment of our pain.

Three mindfulness exercises to use right now to quiet your mind and focus your attention

One of the reasons mindfulness is used is to get yourself calm. If you are a person with a lot of anxiety, your anxiety might get in your way of handling problems, thinking clearly, or addressing something with your full attention.

Mindfulness is one way to lower emotional arousal, center yourself, and help you get back on track. When emotional arousal returns to baseline, accessing the problem solving part of your brain becomes easier.

1)   Inhale to the count of one, exhale to the count of two. Keep going until you get to the bottom of six. Start over. Do this for about three minutes. If you get lost or distracted simply start over. The point is to have something to focus your attention on; which helps cut the distractions of your mind.

2)   Trace your hand. Inhale on the way to the tips of your fingers, exhale on the way to the crevice. This can be done with pen/ pencil on paper or with the finger of the opposite hand. This is a tactile way to “trace” your breath and focus your mind. Keep your attention on your breath.

3)   Pause for three minutes and focus your attention entirely on sound. Try to tune in to every possible nuance of sound. See what you can hear that you typically don’t pay attention to. If your mind drifts, bring it gently back to the experience of hearing.